ALEXANDER ANATOLYEVICH IVANOV MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

ACTIVE

Business

Title

First Name

ALEXANDER

Middle

ANATOLYEVICH

Last Name

IVANOV

Business Name

ALEXANDER ANATOLYEVICH IVANOV MD

Original Issue Date

08/13/2024

Effective Date

08/13/2024

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61114

County

BOONE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/13/2024